Nursing Home Pre-Admission Screening: A Review of State Programs

From January through March of 1981, the Health Care Financing Administration (HCFA) surveyed the agencies of 49 States and the District of Columbia responsible for the administration of the Medicaid program. The purpose of the survey was to determine if the agencies had a nursing home pre-admission screening program for Medicaid patients. Twenty-eight States and the District of Columbia responded that there was a state-wide, pre-admission screening program for Medicaid patients prior to their entry into a nursing home, or that there was a program operating in a portion of the State. HCFA collected information on the scope of the programs, the agencies responsible for conducting pre-admission screening, the composition of the screening teams, and the characteristics of the client assessment instruments. Two States, Virginia and Massachusetts, provided information on program impact. This article presents the findings of the survey and explores several aspects of the Medicaid program influencing the effectiveness of pre-admission screening. It begins with an overview of the policy issues which have influenced the development of pre-admission screening and defines the core components of these programs. We then discuss current Medicaid utilization control mechanisms required of States by statute and the problems associated with these review practices in preventing inappropriate or unnecessary institutionalization. The article then describes and analyzes current State pre-admission screening programs. Finally, we discuss further policy considerations surrounding the effectiveness of pre-admission screening programs in assuring Medicaid patients equitable access to appropriate long-term care services.